摘要
目的比较经皮、经椎旁肌间隙(Wiltse入路)与传统开放3种椎弓根螺钉置钉方式治疗无神经损伤的胸腰椎压缩骨折的疗效。方法将148例单椎、无神经损伤的胸腰椎骨折(AO分型A型)患者根据手术方式不同分为A组(采用经皮椎弓根置钉,67例)、B组(采用Wiltse入路置钉,45例)、C组(采用传统开放置钉,36例)。比较3组手术情况、疼痛VAS评分及影像学参数。结果患者均获得随访,时间12~24个月。手术时间3组比较差异无统计学意义(P>0.05),术中出血量A、B组少于C组(P<0.05),X线透视次数A组多于B、C组(P<0.05)。术后1周及末次随访时,伤椎后凸Cobb角A组大于B、C组(P<0.05),伤椎前缘高度百分比A组低于B、C组(P<0.05)。术后3个月腰痛VAS评分A、B组低于C组(P<0.05)。结论3种椎弓根螺钉置钉方式均是治疗胸腰椎压缩骨折的有效方法,经皮椎弓根置钉和Wiltse入路置钉具有创伤小、患者恢复快、术后腰部疼痛程度轻的优点,但经皮椎弓根置钉术中医患放射线曝露时间长,椎体高度恢复及后凸角度恢复略差。
Objective To compare the effects of the percutaneous pedicle screw fixation,Wiltse approach with pedicle screw fixation and traditional posterior pedicle screw fixation for the compression thoracolumbar fracture without neurological injury.Methods The 148 adult patients with type AO-A of single thoracolumbar fractures without neurological injury were divided into three groups according to the surgical techniques:Group A(67 patients underwent percutaneous pedicle screw fixation),Group B(45 patients underwent Wiltse approach with pedicle screw fixation),Group C(36 patients underwent traditional posterior approach with pedicle screw fixation).The outcomes of three groups including surgery conditions,VAS and radiographic parameters were compared.Results All patients were followed up for 12~24 months.There were no significant differences among three groups in surgery time(P>0.05).Group A and B was less than Group C in blood loss during operation(P<0.05).Group A was more than Group B and C in times of X-ray exposure(P<0.05).At 1 week after operation and final follow-up,Group A was larger than group B and C in Cobb angle of the injured vertebrae(P<0.05).Group A was lower than group B and C in the percentage of vertebral anterior edge height(P<0.05).At 3 months after surgery,VAS of low back pain in group A and B were lower than that of group C(P<0.05).Conclusions The three surgical techniques are effective methods to treat the compress thoracolumbar fracture.Percutaneous pedicle screw fixation and Wiltse approach with pedicle screw fixation have the characteristics of less trauma,rapid recovery and mild low back pain degree after surgery.But percutaneous pedicle screw fixation has more time of X-ray exposure during operation and some limitations in the recovery of vertebral height and kyphotic Cobb angle.
作者
刘夏君
张军
罗鹏明
王新虎
姚福东
LIU Xia-jun;ZHANG Jun;LUO Peng-ming;WANG Xin-hu;YAO Fu-dong(Dept of Spinal Surgery, the Baoji Central Hospital, Baoji,Shaanxi 721008 , China)
出处
《临床骨科杂志》
2021年第1期6-10,共5页
Journal of Clinical Orthopaedics
关键词
胸腰椎压缩骨折
经皮椎弓根螺钉固定
经肌间隙
椎弓根螺钉固定
thoracolumbar fractures
percutaneous pedicle screw fixation
paraspinal approach
pedicle screw fixation
